Antidecubitus immobilization cervical collar

ABSTRACT

A cervical collar is provided which has front and rear semi-rigid portions, attached by hook and loop fasteners. The front portion-comprises a semi-rigid preformed jaw support contoured to follow the jaw line of a patient, and a preformed sternum brace contoured to contact the sternum and upper trapezius of the patient and to support said jaw support. The rear portion of the cervical collar is contoured to follow the curve of the back of the head or occiput and to support the head and neck. The sternum brace has right, left, and central sections, wherein the height of the central section is adapted to correspond to the distance between a patient&#39;s sternum and jaw at the chin and the height of the right and left sections is adapted to correspond to the distance between a patient&#39;s upper trapezius muscle and jaw. The height of the right and left sections is independent of the height of the central section. Further, the jaw support may include a cushioning pad and a covering of anti-decubitus material. In a preferred embodiment, the jaw support of the collar is adjustable, to adjust to the natural angle of the patient&#39;s jaw.

This application is a continuation of application Ser. No. 07,619,040,filed Nov. 28, 1990, now U.S. Pat. No. 5,180.361.

BACKGROUND OF THE INVENTION

Various types of cervical collars have been developed for treatingconditions of the neck and cervical spine. Some of these collars areintended merely as support for whiplash and other such injuries wheresupport for the head and neck is needed. The primary objective for theuse of such a collar is to partially immobilize the head and neck, toprovide support for the head, and to relieve any spasm or strain towhich the neck muscles may be subjected by transmitting weight or forcefrom the head to the shoulders or adjacent area.

Other collars are intended to be used where near complete immobilizationof the head and neck are necessary. There exist presently a multitude ofcervical collars intended to perform one or more of the abovementionedfunctions.

U.S. Pat. No. 3,572,328 to John L. Bond describes an adjustable,flexible cervical collar designed for universal use by providingvertically adjustable movable sections displaceable relative to eachother and to a base portion.

U.S. Pat. No. 2,911,970 to W. L. Bartles pertains to a cervical collarhaving two-piece construction which allows for adjustment of the forwardportion of the cervical collar. This allows for the use of a singlecollar by persons having different length necks, as measured in thefront of the person.

U.S. Pat. No. 3,916,885 pertains to a cervical collar where the entireheight of the collar is adjustable to provide a single collar forpersons having different length necks.

While prior art cervical collars have had various measures of success inimmobilizing the head and neck of a patient, there are several problemsassociated with such collars. First, there has heretofore been atrade-off between immobilizing the head and neck of a patient andpatient comfort while wearing the collar. In order to increase thedegree of immobilization, collars were made more rigid between thepatient's chin, shoulders, sternum, and upper back. This resulted inpressure points and discomfort to the patient.

Prior art collars have not provided optimum immobilization of thepatient. Attempts to provide better immobilization have heretofore metwith only limited success on an extended-wear basis. Frequently,attempting to further immobilize a patient's head and neck will resultin added pressure where the collar rests upon the patient's chest orsupports the jaw. Further, the pressure required to immobilize a patientis generally distributed over a very small area, creating pressurepoints. While these pressure points are uncomfortable for the patient,they present a more serious problem in that such pressure points tend tolead over time to contraction of decubitus by the patient. Therefore,prior art collars have not been suitable for long term immobilization ofa patient.

Decubitus or decubitus ulcers (also known as bed sores, pressure sores,or trophic ulcers) arise when tissues overlying a bony prominence havebeen subjected to prolonged pressure against an external object, in thiscase a cervical collar. Decubitus is basically a breakdown of the tissueoverlying the bone. Decubitus ulcers can affect not only superficialtissues such as skin, but also muscle and bone. Several factorscontribute to the formation of decubitus. Moisture and pressure are twoof the major contributing factors to the formation of decubitus ulcers.Once a decubitus ulcer forms, the ulcer is like an iceberg, a smallvisible surface with an extensive unknown base. There is no good methodof determining the extent of tissue damage. Once decubitus has started,it will continue to progress through the skin and fat tissue to muscle,and eventually bone. Once started, decubitus is very difficult to treatand arrest. In extreme cases, surgical replacement of bone, muscle andskin are required to restore that portion of a patient which suffersfrom decubitus.

SUMMARY OF THE INVENTION

The present invention provides a cervical collar which reduces thelikelihood of contracting decubitus in a patient wearing such collar,yet increases the degree of immobilization achieved by redistributingthe pressure needed to immobilize the patient's head and cervical spine.

The present invention comprises a cervical collar having front and rearsemi-rigid portions. The front portion comprises a semi-rigid preformedjaw support contoured to follow the jaw line of a patient, and apreformed sternum brace contoured to contact the sternum and uppertrapezius of the patient and to support the jaw support. The rearportion of the cervical collar is contoured to follow the curve of theback of the head or occiput and to support the head and neck. Thesternum brace has right, left, and central sections, wherein the heightof the central section is adapted to correspond to the distance betweena patient's sternum and jaw at the chin and the height of the right andleft sections is adapted to correspond to the distance between apatient's upper trapezius and jaw. The height of the right and leftsections is independent of the height of the central section. Further,the jaw support preferably includes a cushioning pad and a covering ofanti-decubitus material.

In a preferred embodiment, the jaw support of the collar is adjustable,to adjust to the natural angle of the patient's jaw, and the right andleft sternum brace portions have recesses which prevent the collar fromplacing excessive pressure on the clavicle of the patient. Also, theparticular design of the collar varies with the intended use, as betweena patient who will be mobile and a patient who will be bedridden.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a plan view of the sternum brace of the front semi-rigidportion of a cervical collar of the present invention.

FIG. 2 is a plan view of the jaw support of the front semi-rigid portionof a collar of the present invention.

FIG. 3 is a plan view of the rear semi-rigid portion of the collar ofthe present invention. FIG. 4 is a perspective view of the collar of thepresent invention.

FIG. 5 is a side view of the collar of the present invention fitted to apatient.

FIG. 6 is a plan view of the alternate embodiment of the sternum braceof the front portion of the collar of the present invention.

FIG. 7 is a plan view of the alternate embodiment of the rear semi-rigidportion of the collar of the present invention.

FIG. 8 is a perspective view of the alternate embodiment of the collarof the present invention.

FIG. 9 is a side view of the alternate embodiment of the collar of thepresent invention fitted to a patient.

FIG. 10 is a side view of a patient to be fitted with a collar of thepresent invention.

DETAILED DESCRIPTION OF THE FIGURES

Referring now to FIG. 1, preformed sternum brace 2 comprises left, rightand central portions 4, 6 and 8, respectively. Preformed sternum brace 2is generally made from some semi-rigid materials such as low densitypolyethylene. Sternum brace 2 is generally symmetrical about a centerline. Sternum brace 2 includes continuous padding 10 along the entirelower portion thereof, where the sternum brace will contact the sternumand upper trapezius of a patient. This padding may be made from amaterial such as expanded polyurethane or neoprene with a low durometer.Padding 10 is secured to sternum brace 2 by plastic rivets 12.Preferably, these rivets are snapped together for ease of assembly, butmay also be hot welded or made of any other suitable construction.Padding 10 may also be secured to sternum brace 2 by adhesive or otherconventional means. The remainder of sternum brace 2 is generally leftunpadded as it does not usually contact the body of the patient.Preformed sternum brace 2 is also equipped with suitable hook and loopfastener material 16 for easy placement and securing on the patient.Retaining strap 15 serves to facilitate application of the collar to apatient by holding sternum brace 2 loosely in position around thepatient's neck before back support 32 is applied.

Cervical collars, such as those of the present invention, are often usedfor trauma patients who have injuries in addition to injuries of theneck, or need more care than just a cervical collar. Some of thosepatients may for instance require a tracheotomy, which might prevent useof a cervical collar, which would cover the patient's throat. Therefore,preformed sternum brace 2 includes opening 14 which allows for access tothe patient's throat or allows access to a tracheal tube when necessary.Very often, when trauma patients are in need of cervical collars such asthe collar of the present invention, associated problems also arise.

Preformed sternum brace 2 is also equipped with multi-position openings18 which provide for attachment and adjustment of a semi-rigid preformedjaw support 3 to preformed sternum brace 2. Also for this attachment issingle position opening 21 in tab 20 of preformed sternum brace 2.

Semi-rigid preformed jaw support 3 is shown in FIG. 2. Preformed jawsupport 3 comprises a backing 22 of a suitable semi-rigid material suchas low density polyethylene and a porous foam pad 24 secured to backing22. Backing 22 is equipped with several vent holes 26 to allow for thepassage of moisture into and out of porous foam pad 24. Porous foam pad24 should be made from an open cell material to provide for aircirculation to the skin of the patient. Vent holes 26 also allowattachment of foam pad 24 by means of hook and loop fasteners 16 asshown in FIGS. 3 and 4. Any other suitable releasable means ofattachment may be used to attach foam pad 24 to backing 22 such asbuttons or snaps. Semi-rigid preformed jaw support 3 also includesopenings 27 and 28 for attachment to preformed sternum brace 2. Opening27 and opening 21 are attached together with a rivet (not shown) such asplastic rivets 12 which secure continuous padding 10 to preformedsternum brace 2. Openings 28 are secured through the use of plasticrivets to multiposition openings 18 in preformed sternum brace 2. Thisallows for adjustment of jaw support 3 with respect to preformed sternumbrace 2 by positioning the angulation of jaw support 3 in relation tosternum brace 2 to match the natural angulation of the patient's jaw, aneven distribution of pressure is promoted by more accurately forming thebrace to the patient's anatomy.

Height A of center section 8 of preformed sternum brace 2 is selected tobe the same as the distance from the patient's sternum 5 to theunderside of the patient's jaw at the chin. Height B of left or rightsection 4 or 6 of sternum brace 2, and specifically distance C isselected to be the height from the patient's upper trapezius to thepatient's jaw at the chin. Distance C is equal to the difference inheight of the patient's upper trapezius 9 and the patient's jaw at thechin 7, as shown as distance C in FIG. 10. These height A and distance C(and height B) are independently calculated from one another. Thus, twopatients, with long necks (as calculated from the jaw near the chin tothe sternum) may require cervical collars with identical heights A, butdifferent distances C if the patient's shoulders are of different sizes.A patient with larger shoulders will have a shorter distance C betweenthe upper trapezius and jaw than a patient with smaller shoulders.

The improvement occasioned by the independent calculation of distances Aand C arises from three specific areas: first, it allows more evensupport of the brace on the sternum and upper trapezius of the patientand smaller chance of movement of the support; second, it allows moreeven spreading of the pressure to the jaw of the patient to maintain thepatient's head in a neutral alignment with respect to the remainder ofthe patient's body; third, this allows the collar to rest on the sternumand upper trapezius while placing little or no pressure on the clavicledue to recess 17 which is specifically cut out to form an arch over theclavicle. Pressure on the clavicle by prior art collars is a majorcontributor to decubitus in the patient. By contrast, the collar of thepresent invention has been cut around the clavicle in the area D,specifically to eliminate pressure on the clavicle. This creates fewerpressure points all around the patient, and allows greater totalpressure to be transferred to the patient's head to limit movementthereof. Thus, the patient's head is more rigidly held, yet morecomfortably.

The elimination of pressure points is critical to the elimination ofdecubitus in the patient. More even distribution of the pressuretransferred from the patient's body to the patient's head, or viceversa, thus substantially reduces the likelihood of contraction ofdecubitus, and the severity thereof if contracted.

While this aids in reduction and elimination of decubitus, it was foundthat still further reduction could be accomplished by the use ofappropriate materials in the production of a collar. Porous foam pad 24has an outer covering 25 which directly contacts the skin of thepatient. The material used for covering 25 may help prevent decubitus.Specifically, where foam pad 24 is permanently attached to backing 22,foam pad 24 can have an outer covering of a material which allowspassage of vapor but not of liquid. The material is microporous andstretchable. The preferred material for use as a covering 25 for foampad 24 is DARLEXX™ from Darlington Fabrics, Providence, R.I. Where foampad 24 may be removed and changed as necessary, cover 25 need not bemade from vapor permeable/liquid impermeable material. The preferredmaterial in this case is DURASORB™ from Quimet Corporation of Nashville,Tenn. DURASORB™ is not a liquid impermeable/vapor permeable materialinstead it functions to wick moisture away from its source therebypromoting rapid evaporation of moisture and significantly reducingdrying time of the padding. Its use should be limited to those instanceswhere the foam padding 24 and 25 may be periodically replaced, as whenthe collar is used for extended periods of time where the patient isambulatory. Periodic removal and replacement of the padding for dryingor hygienic purposes will greatly reduce the incidence of decubitus.

However, where the collar should not be removed or the padding is notreplaceable, as in the alternative embodiment to be explained presently,the padding should be covered with DARLEXX™ which is a liquidimpermeable/vapor permeable material. This allows vapor to pass in andout and allows the skin to breathe and dispose of moisture throughevaporation while preventing the padding from becoming soaked withliquid. Wet padding against the skin of a patient is very conducive todecubitus and should be avoided whenever possible. Thus, the use of aliquid impermeable/vapor permeable material is very useful in reducingthe chance of developing decubitus. This is important where the collarcannot be removed or when a patient is bedridden, such as in theintensive care ward of a hospital.

Referring now to FIG. 3, semi-rigid portion 30 comprises back support 32and head support 34. Both back support 32 and head support 34 are madefrom a semi-rigid material such as low density polyethylene. Backsupport 32 includes continuous padding 10 along the bottom portionthereof where the back support 32 is intended to contact the body of thepatient. Back support 32 also includes recesses 33 to avoid placingpressure on the soft tissue of the back portion of the trapezius muscleand to distribute pressure to the upper back along the spine whichserves to provide greater immobilization and patient comfort. Continuouspadding 10 is held in place by plastic rivets 12. Adhesive attachmentmay also be used. Also attached to back support 32 by plastic rivets 12is hook and loop fastener material 16 which is used to secure backsupport 32 to preformed sternum brace 2.

Head support 34 includes several vents 35 which allow for passage ofvapor from pad 36 through the semi-rigid material. Vents 35 also allowfor attachment of pad 36 by cloth straps 38 and by hook and loopfastener material 16. Head support 34 is attached to back support 32 byrivets 12 through multi-position openings 42 and single position opening44. Multi-position openings 42 allow for adjustment of head support 34for different size heads of patients, and to allow adjustment of theangulation of head support 34 to assure proper and even pressure acrossthe occiput of the patient.

The entire assembled cervical collar of the present invention is shownin FIGS. 4 and 5. Thus the entire configuration as assembled and theinteraction of different portions with each other and the patient may beseen as a whole in FIGS. 4 and 5.

When a patient is fitted with a cervical collar such as a collar of thepresent invention, the collar should be adjusted so that the patient'shead is held in a desired alignment front to back. The collarconfiguration shown in FIGS. 1 through 5 performs such a function whenthe patient is in an upright position. However, if the patient is to bebedridden and in a supine position, the configuration of the humananatomy is different than it is when upright, therefore, theconfiguration (but not the basic design) of the collar should be alteredto provide for a reduced distance from the chin to the sternum. Further,a less rigid rear support may be used since freedom of movementrearwardly will naturally be severely restricted by the bed or othersurface upon which the patient is resting; a rigid back piece willproduce unwanted pressure points. Such a configuration is embodied inthe collar shown in FIGS. 6 through 9.

FIG. 6 shows a preformed sternum brace 102 of an alternativeconfiguration of the collar of the present invention. Preformed sternumbrace 102 comprises left, right and central portions 104, 106 and 108,respectively. Sternum brace 102 is preferably made from some semi-rigidmaterial such as low density polyethylene and is generally symmetricalabout a center line. Sternum brace 102 is similar to preformed sternumbrace 2, but the distances A, B and C have been specifically calculatedfor a supine patient. This includes a reduction of distances A and C asa supine patient will have a smaller distance from chin to sternum.Sternum brace 102 includes continuous padding 110 along the entire lowerportion thereof, secured to sternum brace 102 by plastic rivets 112 oradhesive or other conventional means, and opening 114 which allows foraccess to the patient's throat or a tracheal tube if present.

Sternum brace 102 also differs from sternum brace 2 in that sternumbrace 102 lacks multi-position openings 18. Instead sternum brace 102includes single position openings 118, which, along with single positionopening 121 on tab 120, allow for attachment of preformed jaw support 3.This is the same preformed jaw support shown in FIG. 3 which is used forthe collar shown in FIGS. 1 through 5. In this case, however, foam pad24 is not removable. Foam pad 24 is permanently attached to backing 22by adhesive or other suitable attachment means. Further, outer covering25 is also permanently attached to foam pad 24 and backing 22, and ispreferably made from DARLEXX™. This provides a vapor permeable, liquidimpermeable barrier which allows foam pad 24 to "breathe" and preventsit from becoming soaked with liquid. This greatly reduces the chance ofthe patient contracting decubitus

Sternum brace 102 also includes padding 103 across the entire rearsurface thereof. Accordingly, sternum brace 102 includes sternum bracecover 105. The sternum brace cover is shown in FIG. 6 in outline so thatthe sternum brace 102 may be more clearly and easily seen. Sternum bracecover 105 is held in place be adhesive or other appropriate means ofattachment. Once preformed jaw support 3 is attached to sternum brace102, the sternum brace cover 105 is locked in place. Sternum brace cover105 is made from DARLEXX™ to prevent the pad from becoming soaked.Sternum brace cover 105 includes hook and loop fastener material 16 toallow for attachment of the collar to the patient and for attachment torear semi-rigid portion 130.

Rear semi-rigid portion 130 comprises head support 134 and padding 132.Rear semi-rigid portion 130 includes continuous padding 110 along theentire lower portion thereof, secured to portion 130 by plastic rivets112 (not shown) or adhesive or other conventional means. Hook and loopfastener material 16 is included to allow attachment to sternum brace102. The entirety of rear semi-rigid portion 130 is also covered with aDARLEXX™ cover 133 to prevent padding 132 from becoming soaked. Thatcovering has not been shown for ease of viewing of semi-rigid portion130. Rear semi-rigid portion 130 has only limited support and stiffness,since it is designed for a supine patient, and the surface upon whichthe patient rests will provide any further support necessary. If, forsome reason, more support is needed than would otherwise be achieved byrear semi-rigid portion 130, a removable rigid occipital support madefrom suitable material such as low density polyethylene in the shape offoam pad 132, may be added inside of antidecubitus DARLEXX™ cover 133 toprovide added occipital and lateral support.

It is understood that various other modifications will be apparent toone skilled in the art without departing from the spirit and scope ofthis invention. Accordingly, it is not intended that the scope of theclaims appended hereto be limited to the description as set forthherein, but rather that the claims be construed as encompassing all thefeatures of patentable novelty that reside in the present invention,including all features that would be treated as equivalents thereof bythose skilled in the art to which this invention pertains.

What is claimed is:
 1. A cervical collar comprising:front and backsemi-rigid portions, each having a fixed height; said front portioncomprising a semi-rigid preformed jaw support contoured to follow thejaw line of a patient, and a preformed sternum brace contoured tocontact the sternum and upper trapezius of the patient and support saidjaw support; said back portion contoured to follow the curve of and tosupport the back of the neck and occiput; said sternum brace havingright and left sections, adapted to rest upon the upper trapezius of thepatient and to contact and support the patient's jaw when the head ofsaid patient is in a preferred, predetermined alignment; said sternumbrace also having a central section adapted to rest upon the patient'ssternum and to contact and support said jaw support while said jawsupport contacts and supports the patient's jaw, when the head of saidpatient is in a preferred, predetermined alignment; and said jaw supportincluding a removable foam pad.
 2. The cervical collar of claim 1wherein said jaw support includes a pad having a cover of antidecubitusmaterial.
 3. The cervical collar of claim 2 wherein said antidecubitusmaterial is a stretchable, microporous material.
 4. The collar of claim1 wherein said right and left sternum brace sections each include arecess adapted to form an arch around the clavicle of a wearer.
 5. Thecervical collar of claim 1 wherein said back portion comprises a backsupport and a head support, said back support having multi-positionopenings for attachment and adjustment of said head support.
 6. Thecollar of claim 5 wherein said back support includes a removeable foampad.
 7. The collar of claim 1 wherein said back portion further includesa removable semi-rigid rear head support.